Marlene Reimer

Workplace violence in Alberta and British Columbia hospitals

Workplace violence is a significant and widespread public health concern among health care workers, including nurses. With growing awareness of how practice environments influence patient outcomes and the retention of health professionals, it is timely to consider the impact of workplace violence in hospitals. Registered nurses in Alberta and British Columbia, Canada were surveyed on their experiences of violence in the workplace over the last five shifts. Our results suggest that nurses are experiencing many incidences of violence in a given work week, particularly in the emergency, psychiatric, and medical-surgical settings. Most violent acts are perpetrated by patients, but there is also a significant portion of violence and abuse committed by hospital co-workers, particularly emotional abuse and sexual harassment. Our results also indicate that the majority of workplace violence is not reported. We suggest that using the Broken Windows theory might be a useful tool to conceptualize why workplace violence occurs, and that this framework be used to begin to develop new violence prevention policies and strategies.

Biopsychosocial correlates of lifetime major depression in a multiple sclerosis population.

The objective of this paper was to evaluate the lifetime and point prevalence of major depression in a population-based Multiple Sclerosis (MS) clinic sample, and to describe associations between selected biopsychosocial variables and the prevalence of lifetime major depression in this sample. Subjects who had participated in an earlier study were re-contacted for additional data collection. Eighty-three per cent (n=136) of those eligible consented to participate. Each subject completed the Composite International Diagnostic Interview (CIDI) and an interviewer-administered questionnaire evaluating a series of biopsychosocial variables. The lifetime prevalence of major depression in this sample was 22.8%, somewhat lower than previous estimates in MS clinic populations. Women, those under 35, and those with a family history of major depression had a higher prevalence. Also, subject reporting high levels of stress and heavy ingestion of caffeine (>400 mg) had a higher prevalence of major depression. As this was a cross-sectional analysis, the direction of causal effect for the observed associations could not be determined. By identifying variables that are associated with lifetime major depression, these data generate hypotheses for future prospective studies. Such studies will be needed to further understand the etiology of depressive disorders in MS.

Major Depression and Quality of Life in Individuals with Multiple Sclerosis

Objective: To compare the Quality of Life (QOL) of multiple sclerosis (MS) patients with and without lifetime major depression. Method: Data on 136 MS subjects sampled from the University of Calgary MS Clinic were collected. The WHOs Composite International Diagnostic Interview (CIDI) was used to diagnose lifetime major depression. The MSQOL-54 was administered to evaluate QOL of the subjects. Results: Thirty one (22.8 percent) of the 136 MS subjects had lifetime major depression, However, only 6 of these had a current episode at the time of data collection. MS patients with lifetime major depression had significantly lower MSQOL-54 scores in the QOL domains of Energy, Mental Health, Cognitive Function, General Quality of Life, Sexual Function, and Role Limitation—Emotional than the MS patients without lifetime major depression. Conclusions: Lifetime major depression may have a substantial impact on the QOL of people with MS. Alternatively, MS patients with poor QOL may be at greater risk of major depression.

Indicators of quality in long-term care facilities

Quality of care is of particular importance to residents of long-term care facilities because of the permanency of their situation. In this study indicators of quality of care were generated from data obtained at a primary level from those most affected by the care. The critical incident technique was used to identify the indicators as perceived by 52 residents, 58 significant others, and 37 nursing staff in five long-term care facilities in Calgary, Canada. The 14 major indicators so identified are discussed in this paper.

Major Depressive Disorder and Health Care Costs in Multiple Sclerosis

Objective: Multiple Sclerosis (MS) is associated with elevated levels of depressive symptoms and an elevated frequency of depressive disorders. Depressive disorders, in general, are associated with substantial direct and indirect economic costs, and have been shown to increase the costs associated with the management of medical conditions in a variety of clinical settings. However, the impact of depressive disorders on costs associated with MS have not been evaluated. The objective of this study was to evaluate this association. Methods: The Composite International Diagnostic Interview (CIDI) was used to identify subjects with major depressive disorder in a sample who had earlier been selected for a broader economic evaluation of the costs associated with MS. Costs were measured in two ways: retrospectively (by questionnaire covering a 2-year period) and prospectively (using a 6-month diary). The proportion of subjects reporting any costs and the proportion exceeding various cost thresholds were calculated in subjects with and without lifetime major depression. These proportions were compared using exact statistical tests and confidence intervals. Non-parametric (rank sum) tests were used to compare median costs. Results: Of 136 subjects, 31 had a lifetime history of major depression. MS-related expenses evaluated retrospectively (e.g., house and vehicle alterations and purchases) did not differ depending on major depression status. In the prospective analysis, subjects with lifetime major depression were more likely to purchase vitamins, herbs, and naturopathic remedies (p < 0.01) and more likely to incur costs associated with utilization of services provided by alternative practitioners (p = 0.04). Other differences (e.g., in mental health care, medical specialists, general practitioner visits) were not observed. Conclusions: Contrary to expectation, this study did not find increased direct medical costs in persons with comorbid major depressive disorder and multiple sclerosis. Persons with comorbid MS and (lifetime) major depression did not incur greater costs or utilize more services. The Canadian health care system is guided by principles of universality and is publicly funded and administered, however, the lack of an impact of major depression on utilization may reflect limited access to services. The lack of an association between costs and major depression may or may not be generalizable to health care systems in other countries.

Measuring Quality of Live in Disorders of Sleep and Breathing

Quality of life can be defined as the overall state of well-being that individuals experience as assessed by subjective and objective measures of functioning, health, and satisfaction with the important dimensions of their lives.5 Normally, the scope of measures is limited to health-related quality of life (HRQL), that which is affected by disease, trauma, or treatment thereof.6 While there is no gold standard, HRQL is generally agreed to include physical function, social function, emotional or mental function, burden of symptoms, and sense of well-being.7,8 The measures reviewed here fall within that narrower definition, but it must be noted that sleep apnea in particular impacts quality of life more broadly, including economic status, leisure, and safety, domains not normally included in HRQL measures. The preceding definitions are congruent with quality of life as valued by individuals. An alternative view looks to the values of the larger community as expressed in utility measures of quality of life based on economic and decision theory.9

Aggressive behavior and the brain: A different perspective for the mental health nurse

Mental health nurses often provide care to individuals who have the potential for aggressive behavior. The expression of such behavior is influenced by the functioning of the central nervous system (CNS). The authors present a framework to assist the reader to understand the interrelationships among the limbic system, and frontal and temporal lobes as they relate to the expression of aggressive behavior. The implications for mental health nursing practice include detecting contributing factors such as head injury, temporal lobe epilepsy, alcoholism, and dietary imbalances, and interpreting patient behaviors to colleagues. Suggestions for proactive interventions are also included.

Rehabilitation outcome evaluation after very severe brain injury

Few centres provide long-term therapy for survivors of very severe brain injury who continue in a minimally responsive state. We report on two outcome evaluation projects in association with one such centre in western Canada. In one project a functional scale to detect subtle changes after long-term therapy with the most severely compromised clients (Rancho levels II and III) is being tested. In the other project outcome indicators of change in quality of life after initiation of community-based rehabilitation have been generated by collecting over 400 critical incidents reported by family members, volunteers, staff and a few higher functioning clients. Our intention in this report is to highlight what can be done in terms of rehabilitation and outcome evaluation with clients who seem to be persisting in vegetative or minimally responsive states.